頚椎硬膜内椎間板ヘルニアの1例

抄録

  A 56 year-old man complained of sudden bilateral shoulder pain following Brown-Séquard syndrome without any remarkable trauma. Magnetic resonance imaging (MRI) showed that disc herniation intensely compressed the spinal cord, with a surrounding isointense halo of cerebrospinal fluid (CSF) on T1 and T2-weighted images at the C3/4 level. He presented to our emergency room with tetraparesis, and underwent anterior discectomy and fusion using a hydroxyapatite-triphosphate complex spacer and an anterior cervical plate. A defect in the posterior longitudinal ligament (PLL) was seen, but adhesion between the dura and PLL was not observed. After removal of a fragment of the herniated disc, clear CSF leakage was seen. Dural laceration was sealed with absorbable hemostat and fibrin glue. The outcome was satisfactory, and complete recovery was noted at the 6-month follow-up. There was no neurological change 5 years and 9 months after surgery.

  Intradural cervical disc herniation is relatively rare ; only 32 cases, including ours, have been reported. Definitive diagnosis of an intradural rupture of the herniated disc before surgery is difficult. Characteristic MRI findings may help to confirm diagnosis. The pathogenesis of intradural cervical disc herniation is not clear. We presume that bone fragments included in the herniated disc may play an important role in the pathogenesis, however further histopathological investigations are needed to substantiate the mechanism.